April 2016 Volume 18 Issue 4
Providing Current Information on

Health Insurance Industry Issues and Legislation

Higher Prices + Greater Utilization of Hospital Outpatient Departments
(HOPD) = 44% Increase in Total Healthcare Spending
A just completed American Journal of Managed Care study found that prices for
7 commonly performed services were 21% to 258% higher when delivered at
HOPDs than in physicians' offices. The study also found that the magnitude of
the differences grew over time. The authors determined that the combination
of growing utilization of HOPDs and the large and escalating price differential
increased total spending for the services analyzed by 44% between 2008 and 2013.
Financial Impact of "Minute Clinics" in Dispute
Utilization of retail clinics located in pharmacies, grocery and big box stores has
resulted in a small, but significant increase in health care spending. A study published
in Health Affairs Magazine found that new utilization by those who would not have
gone to a doctor more than offsets the clinics' lower cost per visit versus a doctor's
office, urgent care or emergency room visit. Minute Clinic operators disagreed with
the findings, stating that the analysis does not take into account the impact of
preventative care delivered at the clinics on total healthcare costs.
Drug Company Payments Mirror Doctors' Brand Name Prescribing Practices
Doctors have always disputed the charge that the payments they receive from
pharmaceutical companies have an impact on the drugs they prescribe. A
recent study does not dispute that assertion. However, it does establish a strong
correlation between the amount of money physicians receive from pharmaceutical
companies and their prescribing patterns. It also found a wide variation state to
state of the percentage of physicians taking industry money, with that percentage
being twice as high as in some states as in others.
Supreme Court Takes Up Birth Control Access Again
For the second time in three years, the U.S. Supreme Court has heard a
case challenging the Patient Protection and Affordable Care Act's (PPACA)
requirements regarding provision of contraceptives. Attorneys for the plaintiff
in Zubik v Burwell contend that writing a letter informing the government of
the name of their insurer makes the plaintiff "complicit in sin" by enabling the
employees to get contraceptives. The question is whether this constitutes a
"substantial burden" on the exercise of religion under the Religious Freedom
Restoration Act.
Three Star Preferred Provider Program Additions
Confirmatrix Laboratory
Lawrenceville, GA 30045

Family Counseling Center
Kittanning, PA 16201

Garden City Colon and
Rectal Surgical Practice

Garden City, NY 115301

Integrity Anesthesia Group
Allenwood, NJ 08720
Interactive Speech Associates
Wilmette, IL 60091

Right Choice Emergency Room
Spring, TX 77388

Right Choice Medical Group
Spring, TX 77388

Treatment Center Program
Venice, CA 90291

Villa Santa Maria
Cedar Crest, NM 87008